Oncologic Emergencies | Clinical Medicine

Premium Member Resources: https://ninjanerd.org Ninja Nerds! In this lecture, Professor Zach Murphy presents on Oncologic Emergencies. We review the most high-yield, life-threatening complications of cancer. We begin with neutropenic fever, stressing its significance as an oncologic emergency. We highlight the pathophysiology of chemotherapy-induced immunosuppression, diagnostic criteria, and the immediate need for empiric broad-spectrum antibiotics. Next, we cover tumor lysis syndrome, highlighting the pathophysiology of massive tumor cell breakdown, electrolyte derangements (↑K⁺, ↑phosphate, ↓Ca²⁺), and the risk of acute kidney injury. We emphasize preventive and therapeutic strategies with hydration, allopurinol, and rasburicase. We then discuss leukostasis, focusing on hyperleukocytosis leading to impaired microvascular perfusion. We review its manifestations, such as respiratory distress and neurologic deficits, and outline urgent management with cytoreductive therapy, including hydroxyurea and leukapheresis. Superior vena cava (SVC) syndrome is explored through its classic presentation of facial swelling, venous distention, and dyspnea. We explain the pathophysiology of obstruction by mediastinal tumors and outline the stepwise approach, including imaging and urgent oncologic intervention. We then discuss malignant spinal cord compression, focusing on red-flag symptoms such as back pain, weakness, sensory changes, and bowel/bladder dysfunction. We review MRI as the diagnostic test of choice and immediate management with high-dose steroids, radiation, or surgery. Next, we cover hypercalcemia of malignancy, the most common metabolic emergency in cancer, caused by PTHrP secretion, bone metastases, or excess vitamin D production. Clinical findings such as confusion, constipation, and polyuria are explained, along with acute treatment using IV fluids, bisphosphonates, and calcitonin. Finally, we review malignant cardiac tamponade, emphasizing its pathophysiology of pericardial fluid accumulation, which restricts cardiac output. We highlight clinical features such as hypotension, jugular venous distention, and muffled heart sounds, and the need for urgent pericardiocentesis as life-saving management. Enjoy the lecture and support us below! Table of Contents: 0:00 Lab 0:45 Neutropenic Fever 29:55 Tumor Lysis Syndrome 52:52 Leukostasis 1:10:33 SVC Syndrome 1:30:43 Spinal Cord Compression (Malignant) 1:53:52 Hypercalcemia of Malignancy 2:15:57 Cardiac Tamponade (Malignant) 2:35:36 Comment, Like, SUBSCRIBE! 🌐 Official Links Website: https://www.ninjanerd.org Podcast: https://podcast.ninjanerd.org Store: https://merch.ninjanerd.org 📱 Social Media https://www.tiktok.com/@ninjanerdlectures https://www.instagram.com/ninjanerdlectures https://www.facebook.com/ninjanerdlectures https://x.com/ninjanerdsci/ https://www.linkedin.com/company/ninja-nerd/ 💬 Join Our Community Discord: https://discord.gg/3srTG4dngW #ninjanerd #oncology #oncologicemergencies